Determining the role of discectomy in addition to laminectomy in the treatment of spinal epidural abscesses with concomitant discitis-osteomyelitis: an analysis of reoperation rates

Background: Spinal epidural abscess (SEA) is a rare condition that occurs in 0.2–1.2 out of every 10,000 hospital admissions. Early surgical decompression and antibiotic treatment is the recommended approach. SEA often demonstrates evidence of concomitant discitis-osteomyelitis. There is a lack of research on the importance of discectomy concerning reoperation rates for patients with both SEA and discitis-osteomyelitis. The primary objective is to investigate the role of discectomy on reoperation rates in patients with SEA and concomitant discitis-osteomyelitis. Methods: A retrospective cohort study was conducted following data collection from the electronic medical record. Inclusion criteria included adults aged 18 to 89 yr, diagnosis of SEA, discitis-osteomyelitis, and laminectomy procedure. Exclusion criteria included unavailable preoperative imaging. Reoperation rates were tabulated. Risk factors for reoperation were assessed via Pearson’s chi-squared tests, Fisher’s exact tests, and Welch’s modified two-sample t-tests where appropriate. Results: Twenty-six patients had SEA with concomitant discitis-osteomyelitis. 19.2% (n=5) required unplanned reoperation. 62% (n=16) of patients received laminectomy alone while 27% (n=7) received laminectomy with discectomy. No reoperations occurred when discectomy was performed. However, this was not statistically significant ( P =0.278). The most well-represented causative organism was S. aureus (n=12), and no specific organism was significantly associated with reoperation ( P >0.050 for all). None of the comorbidities or lab values were found to be significant risk factors for reoperation ( P >0.05 for all). Conclusion: When patients have osteomyelitis or discitis-osteomyelitis on imaging, undergoing laminectomy and discectomy may result in a lower risk of reoperation. Level of Evidence: III